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HomeMy WebLinkAbout820 Merganser Dr - Applications/Water Heater - 01/25/2018of 6 Inns F nningr Devela tent & Transportation 281 N. College Ave P.O. Box 580 Fort Collins, Co 90524 Phone 970-416-2740 Fax 224-6134 OVER-THE-COUNTER PERMii'S ONLY Th appdeation Is to be used to apply for the following permits only (check all that apply). ❑ Air Conditioning 0 emoiidon (interior nonral) 0 Electrical Alteration (not service change) ❑ Gas Lighter ❑ Gas Log ❑ eating Unit ❑ Lawn Sprinkler ❑ Mobile Home replacement ❑ Roofing ❑ Sewer Late ❑ Photo -voltaic ❑ entilation AWater Heater ❑ Water Line ❑ Wood/Pellet Stove (must be EPA certified, provide make, model and all applicable Infonnatton on the application. Incomplete applications will not be accepted. # b�MOIS'AD Dates ►lasl► For offl a use only site Address (fag0=9 value of Construction (tabor, materials, profit) ry)e, fir. �` 22D•�I r1 �,„�' �57s caty/state -t+r� p mac! PhoneiVO - �.�� VKmt Name Address citylstow Zip Ph0 3N h�llJ /41/4 4rffi52 tractor i9JWn API/AJ JW-�W Address City/State Zip AW3 46 2 Cc ntracbor City of FL Collins Sales Tax i#-3a ZDa Areyou paying taxes here or by report? © Here AMeport Sa taxnuaabertsfgWiadbyaflaV ate= Are you paying with your trust account? . .Yes ❑ No Is this a residential or commercial project? IKReddentlal ❑ Commercial Ifnesidential,isit mangle. Famlly Detached ❑ Cando/towntwme (single fancily attached) Q Dupfex D Muldfamiiy (apartment) 13 Garage If mmmutW, is it ❑ Sank Cf Bar 0 Church ❑ Hotel/Mdbel ❑ Medical office 17 Office E3 Retail ❑ Restaurant ❑ Other (ex ain) Is ills bufid'a►g 50 years of age or more? ❑ Yes O No Ifyes, you may need to awtad M's'toriCAMAWKWOO If Pis is for a demolition permit, what year was the building constructed? Itimw iv 1975, you wit! need an a9besIs assessmear to submit w ft M& appffaWbm o iaum spnnider/baddiow prevenber, must list licensed plumber. If first time AlC, must list licensed electrician. List dire ca747anynamP orCly of Ca msbe:m w # Plumber - Roata y adatowtedge that I have read this applicatbon and pate that the above informadon is oomph and correct:. I agree to with ad requirements contained herein and oty ordinances and state laws regulating building construction. I know that a . Is not valid until ft has been paid sued issued. Z'd 9670-Z8t7-0L6 Auodwooeoiniesuuewlie d91:90'gt6iuer